Review of Australian Government Health Workforce Programs

Appendix x: Summary of stakeholder roundtable and working group meetings

Page last updated: 24 May 2013

Summary of stakeholder roundtable and working group meetings
RoundtableAttendees Key points
Rural Workforce Distribution, Attraction and Retention

1 November 2012

Australian College of Rural and Remote Medicine

Australian Medical Association

Australian Medicare Local Alliance

Australian Rural Health Education Network

Federation of Rural Australian Medical Educators

General Practice Education and Training

Health Consumers of Rural and Remote Australia

National Rural Health Alliance

Royal Australian College of General Practitioners

Rural Health Workforce Australia

  • A number of initiatives are being funded for recruitment and retention of health professionals to increase rural health workforce but these are seen to be disjointed and in some instances being delivered in isolation. There is a need to almost case manage the process and certainly to create a seamless training, recruitment and retention continuum.
  • Data, research and planning is required to better manage recruitment and retention.
  • There is a need to explore mechanisms for local coordination and integration.
  • The use of the ASGC-RA classification system should be revisited to ensure that incentives are provided at the right place for maximum benefit.
  • This review should focus on what workforce measures are currently working and how the Commonwealth can strengthen the existing system.
  • Junior doctor training in rural/remote locations need to be very well supported and establishment of mentoring systems should be considered to ensure help/advice is always available. This is particularly important for remote and very remote locations.
  • Funding for infrastructure, including accommodation, and maintenance of the infrastructure should be considered.
  • While there was general support for bonded places, the Australian Medical Association disagreed with this policy which was contrary to their stated position of “right to choose”.
  • Greater integration of primary and secondary care is needed and more specialist training is required in rural and remote regions for this integration to occur.
Rural Health Education

2 November 2012

Australian College of Rural and Remote Medicine

Australian Rural Health Education Network

CRANAplus - Council of Remote Area Nurses

Federation of Rural Australian Medical Educators

La Trobe University

National Rural Health Students Network

Remote Vocational Training Scheme

Rural Health Education Foundation

  • Stakeholders expressed the view that Australia is well set to be domestically training sufficient medical graduates, however distribution continues to be a challenge.
  • There is a gap between rural undergraduate training and prevocational and vocational training and this will need to be filled to realise the full potential of the investment in rural undergraduate training programs.
  • A pathway is essential to these students who are ‘lost in the middle’ and one of the ways to do this would be to consider a brokerage model for Rural Clinical Schools (RCS) to buy federally funded intern/specialist training spots.
  • The short-term placement for RCS should be made flexible and possibly replaced by a six week placement requirement to be undertaken in stages. The four week placement should occur with an initial two week placement as a ‘taster’.
  • Rural/regional student recruitment should be 25% or capped at 33% to reflect the rural population.
  • Each region is unique and centralised planning does not work.
  • For students under the University Departments of Rural Health (UDRHs), longer term training (six weeks) is useful.
  • Service learning models should be widely implemented in all UDRHs.
  • Rural dental academic positions in UDRHs linked to dental student training may be an effective pathway to train as well as deliver services in rural and remote regions.
  • Aboriginal Health Worker (AHW) registration was an issue. AHW is an all-encompassing term as some are health practitioners and others are not but still termed as an AHW.
  • Infrastructure and accommodation continues to be an issue in rural and remote regions.
Allied Health Workforce

7 November 2012

Allied Health Professions Australia

Australian Association of Practice Managers

Australian Health Practitioner Regulation Agency

Australian Physiotherapy Association

Australian Podiatry Council

Australian Psychological Society

Occupational Therapists Australia

Optometrists Association of Australia

Pharmacy Guild of Australia

Rural Health Workforce Australia

Services for Australian Rural and Remote Allied Health

  • All professional bodies highlighted the inequities in education and training support provided to the different health professions, with the perception that the bulk of Commonwealth funds goes to the medical profession whilst the allied health professions receive the smallest proportion. There was a suggestion that current medical support programs be expanded to include allied health professions (HECS Reimbursement Scheme, General Practice Rural Incentives Program, Practice Incentives Program, Telehealth consultations items between practitioners, MBS items for chronic disease management).
  • The lack of allied health workforce data is a significant hindrance to workforce planning and policy development.
  • Whilst noting that HWA is currently considering the allied health workforce, concerns were expressed about HWA’s lack of engagement with the sector and application of a “public medical model” to what is primarily a private sector small business model.
  • The current “cluster” funding model for universities is inadequate to ensure appropriate skills and training in entry level allied health courses. Suggest that the funding of allied health courses be in the same cluster as medicine.
  • Participants expressed support for a Commonwealth Allied Health Officer as a mechanism to bring allied health into policy considerations, noting the success of this approach in state and territory governments. Preferably, this will be a person with private sector experience reflective of the working environment of most allied health professionals.
  • Concerns were raised about the lack of engagement by Medicare Locals with allied health practitioners either on their Boards or as members of advisory committees, and failure to engage with existing informal regionally-based allied health networks.
  • The maldistribution of the allied health workforce, particularly in rural and remote areas, is in large part due to the lack of sustainable full-time positions in smaller communities which may require several part-time allied health professionals.
  • Concerns were expressed that the DEEWR Skill Shortage List does not accurately reflect current and short-to- medium term future allied health workforce requirements (ie some professions included on the list are not experiencing a shortage).
Dental Workforce

7 November 2012

Australasian Council of Dental Schools

Australian Dental and Oral Health Therapists Association

Australian Dental Association

Australian Dental Council

Dental Board of Australia

Dental Hygienists Association of Australia

Royal Australasian College of Dental Surgeons

Rural Health Workforce Australia

Dentistry and Medicine

  • Comparisons between Government funding for dentistry and medicine were made, with a general consensus from professional bodies that more funding support should be provided for oral health practitioners and students.
  • Base funding support for the medical workforce is significantly more than dentistry. There should be more of a focus on student HECS loans and rural incentives.
  • Dentists have a significant education debt on completion of their dental qualifications, especially if they pursue dental specialties. The debt in some cases is between $200,000 and $300,000. Funding should be provided to dentists similar to programs such as the medical rural bonded scholarship scheme.
  • Dentistry should not be categorised within allied health as it is more similar to medicine. There are some commonalities with medicine and this should be reflected in Government funding arrangements. There should be a focus on incentive based funding for dentists.
  • Dentistry should have the same funding arrangements as for medicine in areas such as, rural incentives and initiatives, supervision and practice incentives.

Funding (general)

  • Consideration should be made on expanding the Dental Training - Expanding Rural Placements (DTERP) Program. ACODS indicated that dental schools could accommodate twice as many FTEs to what the program is currently funding (DTERP currently funds 5FTEs).
  • There is concern that the current Government funding arrangements could set up a second tier level of oral health care by having the less experienced dentists (graduates) providing treatment to rural and remote and lower socio-economic cohorts. The dental treatment required by these groups, in most cases, is challenging and they should have access to experienced dental practitioners.
  • The government needs to focus more on preventative measures rather than treatment – more funding needed.
  • More infrastructure investment is required in rural areas. Dental schools should play more of a role in rural oral health patient care.
  • There was a consensus that the National Advisory Council on Dental Health should continue and that the workforce recommendations from the Report should be implemented.

Collaborative approach to oral health

  • Engaging the public and private public sectors in service delivery in rural areas is important if we want to have a viable and sustainable workforce.
  • There should be more of a coordinated approach regarding funding in rural areas from Commonwealth, state and council levels.
  • There are concerns about the lack of funding the jurisdictions are allocating to the oral health workforce. It was noted that the Commonwealth cannot control this.
  • There needs to be more focus on a team approach to oral health care (prevention and treatment), particularly in relation to the referral pathways.

Oral health therapists and hygienists

  • Public sector employers need to embrace the flexibility of the dental, oral health therapist and hygienist workforce and utilise their full skill range in oral health care.
  • The oral health therapists and hygienists advocate for Commonwealth dental programs to further expand its scope of practice to include all registered oral health practitioners.
  • Oral health therapists have restrictions working in the private sector. Conversely there are restrictions for hygienists working in the public sector. These restrictions are at a jurisdictional level due to a misinterpretation of the national oral health practitioner registration requirements.

Data collection

  • Historically, international student numbers were not significant in data collection. However now, with the increase of International Dental Graduates (IDGs), it is believed that 15 to 20% of dentists in the Australian workforce are IDGs. IDGs should be included in HWA workforce planning.
  • Dentists should not be included in the allied health workforce.
  • Australian Research Centre for Population Oral Health (University of Adelaide) data is the best available data for workforce evaluations, however some improvements could be made.

Regulatory restrictions

  • There were concerns regarding the state-based drugs and poisons acts and the restrictions they place on dentists. Further concerns were raised in relation to the significant costs associated with the registration requirements to set up a dental practice and other accreditation requirements. Dentists feel that they should be compensated for these costs and they should receive the similar incentives as GPs do to become accredited.
Nursing Workforce

8 November 2012

Australian and New Zealand Council of Chief Nurses

Australian College of Nursing

Australian College of Midwives

Australian Nursing and Midwifery Accreditation Council

Australian Nursing Federation

Coalition of National Nursing Organisations

Congress of Aboriginal and Torres Strait Islander Nurses

Council of Deans of Nursing and Midwifery (Australia and New Zealand)

Nursing and Midwifery Board of Australia

  • Projected workforce shortages in the future combined with the lack of available positions in the present represent a policy dilemma. It is important to continue to fund education and training but there must be a clear pathway for graduates to employment or else nursing will become less attractive as a future career.
  • Retention strategies need to be further developed and targeted appropriately based on the needs of the local community and the practitioners working there.
  • Participants discussed the concept of “work ready”, and the expectation that nurses should be able to perform at fully competent level at graduation. This is impacting on the employment of graduates and creating a perception that a graduate year is a necessity. This constricts the availability of overall employment as there are usually caps on graduate nurse places at each facility.
  • There should be more of a focus on primary care rather than solely on acute care as part of a new, more inclusive model of nursing practice. Participants expressed that the nursing workforce needs to be flexible and have a broad based generalist skill set.
  • In addressing health workforce issues there should be less of a focus on a ‘one size fits all approach’, as medical workforce models are not always appropriate for the nursing workforce.
  • Participants raised concerns in relation to the cost and the amount of study associated with re-entry to the workforce for both registered nurses and enrolled nurses.
  • Concerns were raised about the lack of Commonwealth support for and recognition of enrolled nurses.
  • There needs to be more of an emphasis on nursing leadership, mentoring and supervision. Participants raised concerns about the lack of Commonwealth investment in this area.
Private Health

8 November 2012

Australian Private Hospitals Association

Baptist Community Services

Catholic Health Australia

Healthscope

Ramsay Healthcare

  • The lack of representation for the private health care sector on key decision making bodies in health workforce planning needs to be addressed.
  • Participants all supported a suggestion from Catholic Health Australia that there could be value in establishing a specific private sector advisory body, with high level representation and engagement with Government, ideally reporting directly to the Minister for Health.
  • Significant capacity exists for the private sector to play a greater role in health education and private sector training, provided this is well organised and financial supports are appropriate to meet costs.
  • Participants expressed the view that nursing workforce issues need to be the primary focus of Health Workforce Australia.
  • Concerns were expressed regarding the variability of the quality of nursing graduates, with only a portion of Australian universities producing work ready graduates.
  • Concerns were also expressed about the complexity of the regulatory and industrial environment, which makes it difficult for private operators to implement flexible and innovative training and service delivery systems. Demarcation disputes in the use of the nursing workforce are a particular problem.
  • Participants were supportive of greater use of each of the different levels of nursing qualification but generally opposed to further regulation of health care professional groups, such as assistants in nursing or aged care assistant workers. Current scope of practice issues need to be resolved before further regulation is imposed. Participants also expressed that there should be greater use (and training) of enrolled nurses within the sector.
  • There is a need for involvement of the vocational education and training (VET) sector in health workforce planning.
  • There was broad support for the suggestion that health workforce implications should be considered in the development of new policy proposals.
Scholarships

9 November 2012

Australian College of Nursing

Services for Australian Rural and Remote Allied Health

National Rural Health Students Network

National Rural Health Alliance

Australian Rotary Health

Australian College of Rural and Remote Medicine

Australian Nursing Federation

Australian Institute of Radiography

Royal Australian and New Zealand College of Obstetrics and Gynaecology

  • Participants highlighted the inequity of funding across disciplines (nursing, medical and allied health) and that demand for scholarships far exceeds the current supply.
  • There was a consensus that scholarship schemes should be evaluated, including the value of each scholarship as there is inconsistency between disciplines and within categories (e.g. clinical placement scholarships).
  • Participants highlighted that support programs (such as mentoring or conference placement) to complement the scholarship programs should be considered.
  • There are insufficient positions in graduate year programs for newly graduated health professionals. For some professions (such as medical imaging) this postgraduate year is mandatory for registration under NRAS.
  • There is a lack of allied health data on which to base workforce planning and targeting of incentives.
  • Most participants did not consider bonded places to be an acceptable option for nursing, midwifery or allied health students.
  • The possibility of a centralised funding pool for all scholarships was raised, rather than a different scheme with associated administration for each. Participants raised the following points:
    • All organisations stated that there was pride from students in receiving their specific scholarship (such as PHMSS or JFPP).
    • Some stakeholders noted that it was difficult to navigate through scholarships.
    • It was noted that each discipline has specific needs, which can be catered for better by different schemes. One participant stated that a ‘single Commonwealth funded scholarship scheme’ would only work if there were allocations for each purpose, for example, undergraduate scholarships, CPD scholarships and postgraduate scholarships. The allocation across disciplines could be determined by the number of applications from each discipline or else workforce shortages.
  • Most organisations expressed support for rolling out the HECS Reimbursement Scheme to all health students. However, it was noted this program is administratively difficult and to extend it would require careful consideration.
Aboriginal and Torres Strait Islander Workforce

14 November 2012

Aboriginal and Torres Strait Islander Practice Board of Australia

Australian Indigenous Doctors Association

Congress of Aboriginal and Torres Strait Islander Nurses

Indigenous Allied Health Australia

James Cook University

National Aboriginal Community Controlled Health Organisation

Onemda VicHealth Koori Health Unit, University of Melbourne

Queensland Health

School for Indigenous Health, Monash University

  • A formalised body such as a College of Aboriginal Health “within the Academy” is needed as a conduit of advice for Government and to act as a focal point for the sector.

Expanding Indigenous student horizons

  • Young Aboriginal and Torres Strait Islander students at secondary education level are steered towards non-health vocational education sector occupations, for example, trades in preference to a career in health.
  • Building pathways from school to the VET sector, and on to undergraduate studies, provides opportunities to enter tertiary education.
  • Sometimes tertiary education is not presented as an option at all, particularly to high school students. At the point of tertiary education entry (VET and University) there needs to be promotion of scholarships to students to raise awareness that they are potentially eligible to access more than just the Puggy Hunter Memorial Scholarship scheme.

Educating the current health workforce

  • In the broader community there are stereotypical views about the distribution of Aboriginal and Torres Strait Islander nurses, Aboriginal health workers and Aboriginal and Torres Strait Islander health practitioners. Participants highlighted that not all positions are in rural and remote areas and not all clinical training needs to be completed solely in a rural area.

Harmonisation of the state and territory poisons acts

  • In the NT, the Poisons Act (via Chief Health Officer Gazettal) enables certain Aboriginal and Torres Strait Islander health practitioners to possess and dispense medication, which is not consistent with other jurisdictions. However, the impetus to train health workers with this capability does not exist where the legislation would prohibit these skills being utilised/practised. Limiting prescribing and dispensing rights for Aboriginal and Torres Strait Islander health practitioners and nurses is contrary to the goals of NRAS to enable movement of practitioners across jurisdictional lines.

Addressing the current bottleneck for graduate nurses

  • Participants highlighted that although a graduate nurse year is not required to practise, it is perceived as necessary by many employers and hospitals have arbitrary limits/quotas relating to how many graduate nurses they will employ. There was agreement that potential incentive payments for hospitals to take on a graduate/more graduates should be considered.
  • Participants highlighted that the Practice Nurse Incentives Program may be a vehicle for nursing graduates and/or recruitment to Aboriginal Medical Services, with nurses rotating out from the larger tertiary hospital.
National Health Education

21 November 2012

Australasian Council of Dental Schools

Australian College of Nursing

Australian Dental Council

Australian Indigenous Doctors Association

Australian Medical Association - Council of Doctors-In-Training

Australian Medical Council

Australian Medical Students Association

Committee of Presidents of Medical Colleges

Confederation of Postgraduate Medical Education Councils

Council of Academic Public Health Institutions Australia

Council of Deans of Nursing and Midwifery (Australia and New Zealand)

General Practice Education and Training

General Practice Registrars Australia

Health Workforce Australia

Medical Deans Australia and New Zealand

Royal Australian College of General Practitioners

University of Sydney, Faculty of Health Sciences

  • Concerns were raised about the capacity of the clinical training system to provide appropriate placements for increasing numbers of health students (all health professions, undergraduate, postgraduate and specialist training).
  • Participants noted that the significant increases in enrolments over recent years are exerting considerable pressure on the clinical training system at a time of fiscal restraint on the part of state and territory governments (the main providers of clinical placements) and that this is likely to continue in the future.
  • Participants (particularly those from the tertiary education sector) also noted that there is potential for a negative impact from HWA funding of clinical placements. That is, significant increases in the amount charged by providers (many of which did not previously impose a fee), and the reduction in availability of public sector clinical placements in favour of those funded by HWA.
  • Concerns were also raised about the distribution of health professionals, particularly in regional, rural and remote areas.
  • There were also concerns about the diversity of the health workforce, particularly the enrolment, retention and completion of courses by Aboriginal and Torres Strait Islander students.
Rural Classification Systems Working Group

6 November 2012

Australian Medical Association

Australian Medicare Local Alliance

General Practice Registrars Australia

Royal Australian College of General Practitioners

Rural Doctors’ Association of Australia

Rural Health Workforce Australia

Monash University, Rural Health Research

National Rural Health Alliance

Issues with the current system

  • There was general consensus across the working group that the current ASGC-RA classification system fails to categorise towns effectively in relation to health workforce requirements. There are instances where rural areas are competing with larger regional centres under the same classification, which has created inequity.
  • There are also boundary issues within the current system with substantial anomalies between adjacent towns. There are particular issues in relation to RA 2 and 3 classifications.

Key principles for a new classification system

  • The working group proposed that a classification system should be a structured, macro level system with some flexibility to enable it to be adapted for individual program guidelines. The system needs to be one that all stakeholders can understand.
  • There was strong support for the idea that there should be flexibility at the local level in any new system. For instance, under a ‘pooling of funding’ approach, funding could be directed to regions or locations with local entities allocating those funds based on individual community need.
  • Participants highlighted that it is important for a classification system to use reliable and up-to-date data as population growth changes quite rapidly in some areas and affects community health needs. For example, towns who have been subject to the mining boom.
  • There were concerns that the use of ABS data in relation to any new system may not correctly represent health issues in rural areas. On this point, DoHA noted that the new ASGC-RA can be updated every five years with ABS population census data.

Possible model for adoption

  • The working group discussed the Monash model which is a 13 category classification system. The model has been modified for potential use by Government to six categories. DoHA presented to the group on the revised six-category model including analysis of impacts on different locations within Australia.
  • There was a strong view within the working group that remoteness should be included as an indicator. In addition, the model must include a population size categorisation.
  • There was a consensus that all classification indicators must be justified so all stakeholders are aware of why they have been included, ensuring a transparent system.
  • Establishing evaluation and monitoring parameters will be an important part of setting up a new classification system.
  • Based on the discussions of the working group, the following key principles for classification system reform have been identified:
    • Flexibility at the local level
    • Logical and easy to understand
    • Evidence-based
    • Objective
    • Regularly updated
    • Allows for discrimination between large and small towns
    • Cost-effective

Transition Process

  • The working group noted that, should a decision be made to reform the classification system, it would be important that an announcement and transition dates be communicated to stakeholders as soon as possible. The transition period should allow stakeholders adequate time to adjust particularly in respect of reporting requirements.
  • Working group members also strongly felt that consultations should be undertaken with stakeholders in relation to the implementation of any new system and the effect it will have on the health workforce. Health workforce bodies would be in a position to assist DoHA with a further consultation process to implement and refine changes recommended by the review. There was a suggestion that a reference group should be established to guide the implementation and monitoring of any new classification system.
Districts of Workforce Shortage

9 November 2012

Australian College of Rural and Remote Medicine

Medical Board of Australia/Australian Health Practitioner Regulation Agency

Australian Medical Association

Committee of Presidents of Medical Colleges

Health Workforce Principal Committee

Royal Australian College of General Practitioners

Rural Doctors’ Association of Australia

Rural Health Workforce Australia

  • Participants agreed that there was a continued need for a system to identify those areas that have comparatively less access to medical services.
  • Participants agreed that consideration should be given to applying a different name to this system as ‘district of workforce shortage’ may not provide the best reflection of the data that is being considered.
  • Participants agreed that any system used for this purpose should consider the level of Medicare-rebated medical service provision within a local area against the national average, but not use this as the sole consideration when making workforce shortage determinations.
  • Participants proposed that the following considerations may enhance the accuracy of workforce shortage determinations:
    • the possible application of a 10% buffer the national average level of service provision to ensure classifications identify those areas that have better access than the national average;
    • the consideration of the availability and nature of any hospital services within a local area when providing workforce shortage determinations;
    • the consideration of state and territory averages in an attempt to create a parity in the overall level of medical service provision within each state and territory; and
    • the possible removal of services provided by locum medical practitioners from the billing statistics used to determine DWS.
  • DoHA suggested that the current system could be amended to treat general practice the same as the other specialties by providing annual updates and using remoteness classifications as a basis for providing determinations was agreed.
  • The transition to using a FWE measure to support workforce shortage classifications was not agreed and is still being considered.
  • Participants did not propose to apply DWS to other health professional groups.
  • Participants agreed that benefit would be derived from DoHA providing additional communication materials to support stakeholder understanding of:
    • the methodology that is used for achieving determinations under DWS or a possible alternate system;
    • the linkages and differences between DWS/alternate system and the AoN system; and
    • the requirements applicable to GP Registrars under this system.
  • Participants proposed that eligible locations for return of service obligations under the BMP Scheme be determined according to a remoteness classification system as opposed to DWS.
  • Participants expressed support for consolidating the current suite of Other Medical Practitioner Programs (OMPs) into a single program.